Procedure Use in Encephalitis, Epilepsy, and Meningitis: A Kids' Inpatient Database Study

For a given patient presentation, diagnostic procedure use can vary among clinicians, because certain procedures might pose risks or be viewed as more or less efficacious. We sought to determine which procedures were used most frequently in certain diagnoses (encephalitis, epilepsy, and meningitis) and whether or not those procedures were more successful in diagnosis than less commonly used procedures. In addition, we tested the hypothesis that procedure use would be affected by patient age and/or number of diagnoses. We used the kids' inpatient database to assess both the use and efficacy of selected procedures in the diagnosis of the aforementioned neurological conditions and variation in the number of procedures used based on age and number of diagnoses. Lumbar puncture and neuroimaging were the dominant procedures for encephalitis, and significantly, fewer procedures were used when lumbar puncture rather than neuroimaging was the principal procedure. Electroencephalography and neuroimaging were the dominant procedures for epilepsy/convulsions, but other procedures were equally efficacious. Lumbar puncture was the dominant procedure for meningitis, and significantly, fewer procedures were used when it was the principal procedure. Both age and number of diagnoses influenced the number of procedures used for encephalitis, whereas only number of diagnoses influenced number of procedures for epilepsy/convulsions. For meningitis, there was an interaction between age and number of diagnoses. While based on a sample of American patients, these results help us to better understand current diagnostic procedure use in general and can inform future use in all populations.